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Help Us Help You… Select the Right Safety Storage® ™ Building

Making an informed decision on the purchase of a building which can either reduce or increase your company's liability is as important as recognizing the need to safely house your hazardous materials. Hazardous material storage technology, products, and third party testing agency certification vary greatly. This Hazardous Material Storage Plan Guide will help you selecting the best products to comply with needs and code.

Decisions regarding the storage of hazardous materials can be made only after learning what materials are involved and in what quantities, types of containers employed, and usage procedures. Please take a few moments to complete this form. It will assist us in making the right recommendation to you on the product(s) that meet your exact needs.

Please complete and hit the “send button” to obtain more sales information.

Customer

* First Name
* Last Name
Title
Company
Address 1
Address 2
City
State
Zip Code
Phone
Fax
* Email

Summary of Application

Describe Application
Timing(Date when storage building should be in place)

Materials to be Stored

	Material Type MEK, Isopropyl Alcohol, 39% Sulfuric Acid, etc.	Hazard Class Flam-1A, 1B, 1C; combust II, IIIA, IIIB; corrosive; poison; oxidizers, etc.	Container Type 55-gal drums, 5-gal pails, boxes, bottles, cylinders, pallets, etc.	Quantity of Container Drums, pails, boxes, bottles, cylinders, pallets, etc.
1.
2.
3.

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- Remove additional row.

Application Requirements

1. Location

Location From Property Lines & Location To Important Buildings On Same PropertyIf other, please describe
Indoor? Describe Location. Any Restrictions?

2. Temperature Control

Are there termperature control requirements?YesNo
Heating
Inside Temp Outside Temp
Cooling
Inside Temp Outside Temp

3. Electrical Requirements/Power Supply

4. Separation Requirements/Mechanical Characteristics

Do you need to separate any incompatible materials?YesNo
If yes, explain:
Do any materials have unusual characteristics?(Examples: water reactive, spontaneously combustible, etc.)YesNo
If yes, explain:

5. Operational Requirements (check all that apply):

Will any of the following operations be performed in this building?
Dispensing
Filling
Mixing
Lab Packing
Other:

6. Material Handling Requirements

How are materials moved into storage?
Forklift/Pallets
Hand Truck
Other:
How are materials removed from storage?
Forklift/Pallets
Hand Truck
Other:

7. General Requirements (check all that apply)

Special Paint
Fire Sprinkler Assembly
Drawings (for Approval)
Drawings (for Records)
Remote Alarms (Fire)
Drawings (for Permitting)
Remote Alarms (Spill/Leak)
Safety Shower with Eye/Face Wash
Automatic Dry Chemical Fire Suppression

If other, please describe:

8. Code/Regulatory Requirements

Have you reviewed your storage needs w/ local bldg or fire depts?YesNo
If yes, are there any local codes, regulations or restrictions that must be considered (please explain)?

9. Future Requirements (check all that apply)

Are your future storage needs likely to entail any of the following?
Relocation of storage facility
Expansion of storage facility
Changes in overall needs

10. Special Requirements/Comments

* Required Fields